To the Editor,

Family practice anesthetists (FPAs) are essential to delivery of rural medical services, including surgery, obstetrics, and critical care.1 Family practice anesthetists training demands a significant investment of resources2; therefore, it is alarming that their average career lifespan is fewer than ten years.3 Determining factors affecting FPA retention may help to address the increasing shortage of anesthesia providers. The purpose of this survey of FPAs was to describe characteristics of their training and practice, reasons why they leave practice, and suggestions to improve their retention.

Following research ethics approval (March 2018), we surveyed Canadian FPAs using the online FluidSurveys tool (Appendix). Survey questions were developed using literature review, focused discussion, and pre-testing on two former FPAs (now Royal College of Physicians and Surgeons of Canada accredited (FRCPC) anesthesiologists), a FRCPC anesthesiologist, and one FPA.4 Snowball sampling began with two authors (R.E., M.D.) who have completed FPA training and encouraged FPA colleagues to circulate the survey link. FPA program assistants across Canada also distributed the invitation to FPA contacts. Recipients were informed that responses would be used for research and that survey completion implied consent.

One hundred and sixty-four Canadian FPAs responded to the survey (of an estimated 500 practicing in Canada).1 Practice location was distributed across Canada, with representation from Yukon/Northwest Territories/Nunavut (8/140, 6%), British Columbia (32/140, 23%), Alberta (20/140, 14%), Saskatchewan (5/140, 4%), Manitoba (6/140, 4%), and Ontario/Quebec/Maritime provinces (69/140, 49%). Respondents were primarily male (124/164, 76%), aged 30–49 yr (96/162, 59%), currently practicing as an FPA (142/164, 87%), practiced in communities with 5,000–19,000 residents (87/144, 60%), and worked with 1–3 FPA colleagues in their community (73/158, 46%). Demographic characteristics are outlined in the Table.

Table Characteristics of Canadian FPA respondents
Full size table

Of the FPAs that indicated they were no longer practicing, the most common reason provided was moving to a new community (6/17, 35%), followed by personal/family reasons (4/17, 24%). Less common reasons included retirement (2/17, 12%), burdensome call (2/17, 12%), and feeling overwhelmed by the responsibilities of an FPA (2/17, 12%). Of note, no respondents indicated they discontinued practice as an FPA because of financial reasons (0/17).

When asked what would help support FPA providers to continue FPA practice, respondents indicated opportunities to do refresher time in a centre with a larger volume of complex cases (n = 108/161, 67%), an FPA locums list (90/161, 56%), support from hospitals and health regions in recruitment (84/161, 52%), formal mentoring program with FRCPC anesthesiologists (69/161, 43%), financial incentives (60/161, 37%), and a formal mentoring program with an FPA (49/161, 30%) would be helpful.

Our findings contribute to understanding the characteristics of Canadian FPAs and the reasons they discontinue FPA practice. The most common reason provided for ending FPA practice was moving to another community, which may reflect the larger problem of retaining family physicians in rural areas.5 Future research could investigate the reasons FPAs move away from their communities. Although no respondents cited financial reasons for discontinuing FPA work, 37% of respondents overall indicated that financial incentives might support continued practice as an FPA. These findings suggest that, while financial compensation may sweeten the deal, it may not alter fundamental concerns of excess call, isolation, or address personal or family-related issues. Further research could explore what kinds of financial incentives might help, if FPAs think they are fairly compensated, and whether financial incentives alone would retain FPAs in practice. Refresher time for skill enhancement would be very welcome, but FPAs struggle to find locums or colleagues to cover clinical duties while away. Professional bodies, specialist anesthesiologists, and hospital leadership should prioritize the creation of a formal refresher program in addition to addressing human resource issues such as a list of locums and recruitment of new FPAs to rural communities.